Provider Demographics
NPI:1275643967
Name:KERNER, JEFFREY K (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:K
Last Name:KERNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BASSETT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1802
Mailing Address - Country:US
Mailing Address - Phone:302-328-0669
Mailing Address - Fax:302-328-8937
Practice Address - Street 1:200 BASSETT AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-1802
Practice Address - Country:US
Practice Address - Phone:302-328-0669
Practice Address - Fax:302-328-8937
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0002172208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000036803Medicaid
DE0000036803Medicaid
DEB66390Medicare UPIN